Provider Demographics
NPI:1588996011
Name:NORLAND, GRANT J (DPT, CSCS)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:J
Last Name:NORLAND
Suffix:
Gender:M
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8556 POWERS PL
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-9390
Mailing Address - Country:US
Mailing Address - Phone:952-649-1001
Mailing Address - Fax:
Practice Address - Street 1:7210 WASHINGTON AVE S
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3513
Practice Address - Country:US
Practice Address - Phone:952-649-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8860225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist